Monday, May 04, 2009

PBS Frontline: "Sick Around the World": but most countries have systems more "private" than we think

The second part of the PBS Frontline “sick around …” series goes abroad for an hour for “Sick Around the World,” directed by Jon Palfreman. The website is this.

TR Reed visits five democracies.

Leading off is Britain’s National Health System, NHS. No one pays a bill and no one goes bankrupt. The cost per person is about ½ in the US. The show goes to Whittington Hospital. Brits pay for health care with higher taxes.

Waiting lists have come down from 18 months to about 2 months for a hip replacement. Hospitals compete for government money.

Nigel Hawkes, editor of the London Times, also reports. He says that in Britain hospitals compete “to survive” not for profit.

Health care starts with the “gatekeeper”, the family doctor or GP.

The second country was Japan, the second richest country in the world. Like Britain, they spend half what we spend per person. Japan has the longest life expectancy in the world, and lowest infant mortality. There is private “social insurance” which is mandatory. Japanese consumers don’t have to see a GP first or even make appointments.

Japan’s system, while quasi private, has only one payment system with prices controlled by the government. Japanese manufacturers make machines that they can sell to government according to the “price book”. Insurance companies must follow guaranteed issue, and if someone loses a job he can buy into a community plan.

A room in a common room in a hospital in Japan is $10 a night, or $90 for a private room. But hospitals, rather than patients, may be getting into financial difficulty.

In Germany, about 90% are covered by the national system. Von Bismarck originated the original idea of universal coverage. But the hospitals and doctors are actually private. Waiting lists are shorter than in Britain but longer than in Japan. The is mandatory universal coverage, with progressive premiums, and private insurers.

German insurance plans compete for customers, although they cannot make profits. They are a bit like American Blue plans. The Germans make it affordable by taking the profit motive out. There have been issues with doctors believing they are undercompensated, and they have even “struck”. One problem is that Germany lets the “rich people opt out.”

The next country is Taiwan. Their system is a lot like US Medicare, with one insurer, or a bit like Canada’s. There’s no gatekeeper and no waits. Patient overuse is monitored by a “big brother” system. They use smart cards to track patient use.

Switzerland had a system more like the US until 1994, when it adopted mandatory insurance. It does allow insurance companies to profit. Nobody goes bankrupt in Switzerland, either. Premiums are higher, about $700 a month for a typical family. Switzerland’s is the most capitalist of the systems examined.

Insurance companies must accept everyone and can’t make a profit on basic care. Everyone must purchase health insurance or the government will buy it for the poor. And hospitals must give one standard of care with set prices. We have pieces of these plans with Medicare, the VA, and the poor.

It would have been nice to cover the Canadian system.

Can we make up our minds now for health care reform?

The attribution for the Wikimedia GNU picture of the Berlin Reichstag is here. I visited Berlin in May 1999.

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